Acute Pulmonary Embolism in Critically Ill Patients with COVID-19

  1. Madhura Manjunath
  2. Julio Miranda
  3. Liana Fraenkel
  4. Paul Mange Johansen
  5. Blessing Phinney
  6. Georgianne Valli-Harwood
  7. Cynthia Callahan
  8. Hafez Alsmaan
  9. David Oelberg

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Abstract

Since the discovery of the novel coronavirus (SARS-Co-V-2) in December 2019, multiple characteristics have been reported, as our understanding of this new disease unfolds. One such association is its tendency to cause thromboembolic events, particularly venous thromboembolism 1,2 . In a four-week period during the initial spread of COVID-19 at a 300 bed community hospital in western Massachusetts, 23 patients who were PCR positive for SARS-CoV-2 RNA required treatment in either the intensive care unit (ICU) or intermediate/step-down unit (SDU). All patients were treated with standard DVT prophylaxis from the time of admission, except for two patients who were on full anticoagulation for chronic atrial fibrillation. Of the 23 patients, 7 (30%) were diagnosed with acute, clinically significant, pulmonary embolism (PE). Four of the 7 manifested evidence of acute cor pulmonale, one of whom succumbed as a direct consequence of a massive PE. Other markers were reviewed in the 7 patients to identify trends that could allow for early suspicion of PE in COVID-19 patients. Although D-dimer tended to rise during the hospitalization relative to the control group, the results were inconsistent, and there were no other meaningful distinguishing features between the groups at the time of admission.

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    SciScore for 10.1101/2020.05.22.20110270: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Informed consent was waived based on criteria outlined in 45 CFR 46.104(d)(4).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.05.22.20110270v1 on medRxiv